Introduction to Personality Disorders Flashcards
Definition of personality disorder?
- abnormality of social relationships and functioning
- is persistent
- inflexible and enduring pattern of perceiving, relating to and thinking about the outside world/self
What are personality disorders characterised by?
- disruptions in the mind
- subjectivity, consciousness, intentionality and the unconscious, agency
What are the categorical approaches of diagnostic systems?
- A (paranoid, schizoid, schizotypal)
- B (antisocial, borderline, narcissistic)
- C (avoidant, dependent, obsessive-compulsive)
What is the morbidity (illness/suffering) of personality disorders?
- social functioning (impaired social adjustment, issues in relationships)
- mental disorder (instability of mood, depression, anxiety, panic attacks etc)
- criminality (associated with violent behaviour)
What are some of the co-morbid health problems that accompany personality disorders?
- depression
- bipolar disorder
- anxiety
- substance misuse
- ADHD
- eating disorders
- somatisation
Definition of complex trauma?
-repeated traumatic events that occurred during a persons early psychological development
Characteristics of complex trauma?
- dissociation
- somatisation
- re-victimization
- affect dysregulation
- disruptions in identity
Definition of simple trauma?
- single traumatic incident that threatened potential future existence
- likely not a background in mental health problems
Felitti et al (2002)
adverse childhood experiences
- 17,000 US people completed retrospective survey, diagnosed with emotionally unstable personality disorder
- 2 out of 3 had at least one adverse experience
- 1 in 6 reported 4 or more ACEs
- experiences included physical abuse, separation, emotional neglect, household mental illness etc
What is complex PTSD characterised by?
- re-experiencing in the present
- avoidance
- excessive current threat
- disturbances in self organization
- affect dysregulation
- negative self-concept
- disturbances in relationships
What are the psychosocial factors of BPD (borderline personality disorder)?
- parental separation or loss
- family history of mood disorder/ substance misuse
- abnormal parenting attitudes (low care with high overprotection)
- childhood trauma
What are the genetic causes of personality disorders?
- little evidence of a link to schizophrenia or mood disorder
- BPD had concordance rate of 35% in MZ twins, but 7% for DZ twins
- aggressive antisocial behaviour is more heritable than non-aggressive
What are the neurotransmitter causes of personality disorders?
- impulsiveness, auto-aggression and outwardly directed aggression are linked to serotonergic dysfunction
- enhanced dopaminergic activity in psychotic-like thinking
- noradrenergic abnormalities associated with risk taking and sensation seeking
What are the developmental theories of personality disorders?
- Bowlby (1969) attachment theory refers to how mothers and babies form attachments in early months of life
- may have insecure attachments, those with personality disorders have greater incidence of anxious/ambivalent/avoidant attachment
- Kernberg (1975) found excessive aggression leads to splitting
How is medication used as treatment for personality disorder?
- current randomized trial of clozapine
- limited evidence for mood stabilisers
- treats symptoms but not root
- has issues (overmedication, misdiagnosis etc)
What are the psychological therapies for BPD?
- dialectical behaviour therapy (DBT) (strongest evidence)
- mentalisation-based therapy (MBT) (strongest evidence)
- transference focused therapy
- therapeutic community
- schema focussed CBT
What is the biosocial theory for BPD?
- interaction between emotional vulnerability and pervasive invalidation
- pov of child is negated by caregiver so develop maladaptive ways of coping leading to behaviour problems (emotional dysregulation)
- cycle of emotional vulnerability, pervasive invalidation and emotional dysregulation
What is the emotional vulnerability of people with BPD?
- high sensitivity (immediate reactions, low threshold for emotional reactions)
- high reactivity (high arousal, extreme reactions)
- slow return to baseline (long-lasting reactions, contributes to high sensitivity for next stimulus)
What did the randomized clinical trials of DBT find?
- found it was superior to controls in 4 independent research labs
- reduced suicide attempts, medical risk, drug abuse, depression, anger, ER admissions
- increased global and social adjustment
How is reflective function and attachment linked to personality disorders?
-Fonagy (1994) found strong relationship between RF and scores in strange situation tests
What’s the neurological basis of mentalisation?
- right hemisphere is specialised for emotion and social cognition
- optimal development associated with development of affect regulation associated with the VMPF cortex
- arousal and mentalisation
What are the failures of mentalisation?
- psychic equivalence
- teleological stance
- hyperactive mentalisation and pretend mode (overthinking without feeling)
What’s involved in transference focussed therapy?
- object dyads in which positive and negative object representations are kept apart
- focuses on understanding the positive and negative attributions to relationships and helping them tolerate the positive and negative attributes in other people
What’s involved in therapeutic community?
- group of patients will be invited to participate with onsite staff
- has important and central role in helping people to understand and tolerate their relationships with others
